Bronchiectasis

Write about Bronchiectasis here.


• Chronic disease characterised by irreversible dilatation of bronchi due to bronchial wall damage resulting from chronic infection and inflammation

Impaired mucociliary clearance leads to accumulation of secretions

• Accumulation of secretions predispose to bacterial infection 

• Infection provokes an inflammatory response, increased mucus production and impaired ciliary function

• Excessive inflammation causes tissue damage

• Damage to the bronchial wall produces dilatation of bronchi and disruption of mucociliary clearance.


Aetiology:

Infections

(severe infections one of commonest causes of bronchial wall damage and bronchiectasis)

• In kids - pertussis and measles

• In adults - pneumonia (Strep. pneumoniae, Staph Aureus, Klebsiella pneumoniae)

TB still common cause in developing countries


• Bronchial obstruction:

Tumour (e.g. bronchial carcinoma)

• Foreign body

• Lymph node enlargement (especially causes middle lobe bronchiectasis)


  Immunodeficiency:

• Hypogammaglobulinaemia

• Selective immunoglobulin deficiencies

• HIV

Usually present with recurrent RTIs in childhood, if Dx not established until adulthood, bronchiectasis may have developed


Allergic Bronchopulmonary Aspergillosis:


• Ciliary dyskinesia:

Primary ciliary dyskinesia is an Autosomal recessive.  With situs inversus = Kartagener's


Associated diseases:

• Rheumatoid Arthritis

Ulcerative Colitis

Crohn's Disease

• Coeliac Disease


• Clinical Features:

• Chronic cough

• Production of copious purulent sputum

• Haemoptysis (intermittent)

• Fever and pleuritic pain (in infective cases)

• Chronic severe bronchiectasis -> malaise, weight loss and halitosis

• Coarse crackles

Clubbing

• Systemic spread possible - cerebral abscess and secondary amyloidosis, though unlikely with antibiotic control


• Investigations:

• CXR - peribronchial thickening - parallel tramline shadowing, or cystic dilated bronchi

• Sputum microbiology

• High Resolution CT

• Serum immunoglobulins, CF sweat test, Aspergillus precipitins (ABPA) or skin prick test

• Bronchoscopy

• Spirometry


Treatment:

• Rx of underlying cause if possible (rarely)

• Chest physio and postural drainage (twice daily)

• Abx - high doses are required to cross the scarred mucosa and purulent secretions

• Bronchodilator drugs

• Inhaled steroids

• Sx excision

• Tx if disease has progressed to respiratory failure